Provider Demographics
NPI:1366903072
Name:GONZAGA, SAUL GAMALIEL (BCBA)
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:GAMALIEL
Last Name:GONZAGA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MOHAWK ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1500
Mailing Address - Country:US
Mailing Address - Phone:661-634-0789
Mailing Address - Fax:888-886-4071
Practice Address - Street 1:901 TOWER WAY STE 304&306
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1585
Practice Address - Country:US
Practice Address - Phone:661-634-0789
Practice Address - Fax:888-886-4071
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-35306103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-19-35306OtherBEHAVIOR ANALYST CERTIFICATION BOARD